Moral Problems in Medicine: : A Practical Coursebook

Michael Palmer’s book is, as the title suggests, a work which examines ethical questions as they arise in and from the world of medicine and health care. As the author says in the introduction: “It is primarily a course book, providing the instructor, student and interested reader with a step‐by‐step guide to ethical theory”. As a relative newcomer to the discipline myself, I believe the book meets this primary objective admirably. It should, however, be of use to other interested groups such as clinicians and GPs as well as those responsible for managing the delivery of health care generally.

The book is based on a course delivered by the author at Manchester Grammar School and it successfully combines two requirements of an introductory textbook. First, it is sufficiently accessible and engaging for the reader to become enthusiastic to learn more from other sources and second, it is informative and academic enough to demonstrate the complexity and depth of the material it discusses.

With regard to the wider audience and readers of this journal in particular, as an introductory text it will serve to familiarise those who work in management with the normative ethics aspect of moral philosophy as it affects their working lives. Managers would do well to consider some of the moral questions it raises and examine whether their own views and attitudes to issues such as abortion and euthanasia have a sound philosophical basis or whether they are in fact a mixture of judgement and opinion which may not withstand rigorous examination. Indeed, many of the ethical questions which all of us face from time to time in our daily lives are raised and examined in a helpful and illuminating way.

A brief introductory chapter explaining how the book deals with normative rather than meta‐ethics is followed by chapters on four broad topics: egoism; utilitarianism (specifically the work of Jeremy Bentham and John Stuart Mill); deontology (concentrating on the work of Immanuel Kant); and determinism and free will.

Many textbooks in this area tend to limit discussion to the central themes of consequentialism and deontology. By incorporating egoism and determinism and free will as well as a brief but helpful appendix on meta‐ethics, Palmer is able to take a broader and more circumspect view of moral philosophy as it applies to human relations generally and the world of health care particularly.

Each subject area occupies two chapters. The first outlines the theory and the second discusses the points raised. To help contextualise the arguments, there are comprehensive extracts from classic works in the field as well as contributions from philosophers such as Peter Singer, W.D Ross and Bernard Williams. Exercises and questions challenge the reader to consider further the dilemmas which are posed and each chapter ends with a useful bibliography referencing further works for those who wish to extend their reading.

Extracts are deliberately evocative and serve to crystallise the issues relevant to the theory being discussed. For instance, the section on euthanasia ends with a piece by Stewart Alsop that concludes:

[t]he terrible thought occurred to me “If Jack were a dog”, I thought, “what would be done with him?” The answer was obvious: the pound, and chloroform. No human being with a spark of pity could let a living thing suffer so, to no good end (Alsop, 1974).

The text is punctuated refreshingly with regular blocks of questions such as: “Given its limited resources, should a hospital always give priority to the young over the old?” and “Is it a valid criticism of utilitarianism that it permits medical experimentation on the helpless?” These question sections alternate with suggested exercises of the type: “A debt can be met by selling off my property, be it my house, my kidney or my foetus”. Discuss.

I found Moral Problems in Medicine educative, accessible and informative. It covers ground which any manager, and particularly those employed in the health‐care setting, should be aware of and informed about. It would also be a useful text for anyone considering philosophy as part of their further or higher education. Palmer has produced an introductory text which should encourage people to read and reflect more in this area and in this way I hope and believe it will serve to stimulate interest and debate within the discipline of moral philosophy.